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Interventions for the Prevention or Management of Childhood Obesity: A Review of the Clinical Evidence [Internet]

Over 30% of children and youth in Canada are considered overweight or obese. Obesity is caused by long-term energy imbalances, whereby daily energy intake exceeds daily energy expenditure. Obesity if often defined by body mass index (BMI), calculated as weight in kilograms divided by height in meters squared (kg/m2). BMI varies in children and youth, thus values are typically compared to reference population charts to obtain a ranking of BMI percentile for age and sex. According to the World Health Organization (WHO), among adolescents, overweight is defined as one standard deviation above the mean BMI reference value for age and sex and obesity is defined as two standard deviations above the mean BMI reference value for age and sex.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: December 13, 2013
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Treatment of childhood obesity: a systematic review

Bibliographic details: Staniford LJ, Breckon JD, Copeland RJ.  Treatment of childhood obesity: a systematic review. Journal of Child and Family Studies 2012; 21(4): 545-564 Available from: http://link.springer.com/article/10.1007%2Fs10826-011-9507-7

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Promoting physical activity in preschoolers to prevent obesity: a review of the literature

This literature review summarizes clinical recommendations for adequate physical activity and reviews recently published studies that focus on identifying common factors associated with physical activity levels among preschoolers in the United States and Canada. Currently, there is inconsistency in both the definition of and recommendations for physical activity. In addition, there is relatively little research in this area. Common factors and contexts associated with physical activity levels in preschoolers in this review included (a) child characteristics; (b) interpersonal dynamics between preschoolers and their families, childcare providers, and health care providers; (c) childcare setting; and (d) neighborhood environment.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Parent-only vs parent-child (family-focused) approaches for weight loss in obese and overweight children: a systematic review and meta-analysis

Families are recommended as the agents of change for weight loss in overweight and obese children; family approaches are more effective than those that focus on the child alone. However, interventions that focus on parents alone have not been summarized. The objective of this review was to assess the effectiveness of interventions that compared a parent-only (PO) condition with a parent-child (PC) condition. Four trials using a similar between-group background approaches to overweight and obese children's weight loss met the inclusion criteria, but only one trial reported sufficient data for meta-analysis. Further information was obtained from authors. Meta-analysis showed no significant difference in z-BMI from baseline to end of treatment between the conditions (three trials) or to end of follow up (two trials). The trials were at risk of bias and no single trial was at lower risk of bias than others. There is an absence of high quality evidence regarding the effect of parent-only interventions for weight loss in children compared to parent-child interventions, but current evidence suggests the need for further investigation.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

[Randomized controlled school based interventions to prevent childhood obesity: systematic review from 2006 to 2009]

The prevalence of overweight and obesity in children has increased to epidemic levels. Several authors have suggested that school is the best place for effective prevention programs. The purpose of this systematic review was to assess the evidence of randomized controlled trials concerning long-term (equal to or more than 9 months) observations at schools and published in the database of MEDLINE/Pubmed from January 1st of 2006 to February 28 of 2009. Ten studies were analyzed. Overall, regarding the design, the intervention components, target population age, intervention periods, educational techniques, cultural characteristics of the population, and outcome measures were heterogeneous. The results were modest. The outcomes showed a positive impact on lifestyle as intakes of fruits and vegetables increased, consumption of sugar-sweetened carbonated beverages decreased, and sedentary behaviors and adiposity were reduced. Generally, there were no significant reductions for BMI. These results warrant more strategies to achieve parental involvement, reduction of dropouts, and additional studies assessing different educational systems and cultural environments, including those in Latin America. Longer follow-up periods are also required.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Trials of interventions for pregnant women who are obese to lose weight and improve pregnancy outcomes.

Pregnant women who are obese risk serious complications for themselves and their children. The mother is more likely to develop diabetes or high blood pressure or pre‐eclampsia during pregnancy, and the pregnancy may end in a miscarriage or stillbirth. The baby could have serious anomalies at birth, including spina bifida, cardiovascular anomalies, cleft lip and palate, or limb reduction anomalies. Some obese women have premature births. At birth, the labour may be longer and other complications can lead to a caesarean birth. The baby may also be bigger at birth than is normal, and there is evidence that the children of obese mothers go on to be obese. The advice for obese women in managing their weight during pregnancy is that weight loss should be avoided, and weight gain should be between 5.0 and 9.1 kg. Yet observational studies of large numbers of pregnant women indicate that some obese women, especially those who are heavier, lose weight during pregnancy. We do not have any clear results that indicate that losing weight when pregnant is safe for a mother who is obese, or for her baby. This Cochrane review aimed to evaluate trials that were designed for obese pregnant women to lose weight. No randomised controlled trials were found. We recommend that further research is conducted to evaluate the safety of interventions for weight loss when a woman is pregnant and obese for the mother and her baby.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials

Effective interventions are needed to address the growing epidemic of childhood obesity. In the past 35 years, family-based approach has gradually developed as a preferred intervention. This review aimed to examine the methodological rigour and treatment effectiveness of family-based interventions according to intervention types and theoretical orientations. A total of 15 randomized controlled trials (RCTs) of family-based lifestyle interventions for children and adolescents aged 2-19 years were included. The adapted Methodological Quality Rating Scales (MQRS) and a four-grade qualitative scoring scheme were adopted to evaluate the methodological rigour and the effectiveness of treatment, respectively. The average MQRS score was 7.93 out of 14 points. Ten of the 15 RCTs had well aligned their research questions with appropriate research methods. The overall short-term outcome of the15 RCTs were satisfactory with an average score of 3.1. Family-based interventions rooted in behaviour theory achieved better results than those theoretically connected to family systems theory in terms of treatment effectiveness. Results suggest future studies to improve the methodological design and continue to explore the potential of the family systems approach.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Educational interventions in childhood obesity: a systematic review with meta-analysis of randomized clinical trials

OBJECTIVE: To assess the effectiveness of educational interventions including behavioral modification, nutrition and physical activity to prevent or treat childhood obesity through a systematic review and meta-analysis of randomized trials.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

School-based programs aimed at the prevention and treatment of obesity: evidence-based interventions for youth in Latin America

BACKGROUND: Rapidly rising childhood obesity rates constitute a public health priority in Latin America which makes it imperative to develop evidence-based strategies. Schools are a promising setting but to date it is unclear how many school-based obesity interventions have been documented in Latin America and what level of evidence can be gathered from such interventions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Obesity: a systematic review on parental involvement in long-term European childhood weight control interventions with a nutritional focus

In Europe, about 20% of children are overweight. Focus on parental responsibility is an effective method in weight control interventions in children. In this systematic review we describe the intensity of parental involvement and behaviour change aimed at parents in long-term European childhood weight control interventions. We include European Union studies targeting parents in order to improve children's weight status in multi-component (parental, behaviour change and nutrition) health promotion or lifestyle interventions. The included studies have at least one objectively measured anthropometric outcome in the weight status of the child. Parental involvement was described and categorized based on the intensity of parental involvement and coded using a validated behaviour change taxonomy specific to childhood obesity. Twenty-four studies were analysed. In effective long-term treatment studies, medium and high intensity parental involvement were identified most frequently; whereas in prevention studies low intensity parental involvement was identified most frequently. Parenting skills, generic and specific to lifestyle behaviour, scored frequently in effective weight control interventions. To list parental skills in generic and specific to lifestyle, descriptions of the included studies were summarized. We conclude that intensity of parental involvement and behaviour change techniques are important issues in the effectiveness of long-term childhood weight control interventions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Family-focused physical activity, diet and obesity interventions in African-American girls: a systematic review

Obesity interventions that involve family members may be effective with racial/ethnic minority youth. This review assessed the nature and effectiveness of family involvement in obesity interventions among African-American girls aged 5-18 years, a population group with high rates of obesity. Twenty-six databases were searched between January 2011 and March 2012, yielding 27 obesity pilot or full-length prevention or treatment studies with some degree of family involvement and data specific to African-American girls. Interventions varied in type and level of family involvement, cultural adaptation, delivery format and behaviour change intervention strategies; most targeted parent-child dyads. Some similarities in approach based on family involvement were identified. The use of theoretical perspectives specific to African-American family dynamics was absent. Across all studies, effects on weight-related behaviours were generally promising but often non-significant. Similar conclusions were drawn for weight-related outcomes among the full-length randomized controlled trials. Many strategies appeared promising on face value, but available data did not permit inferences about whether or how best to involve family members in obesity prevention and treatment interventions with African-American girls. Study designs that directly compare different types and levels of family involvement and incorporate relevant theoretical elements may be an important next step.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Effectiveness evaluation of healthy lifestyle interventions in childhood obesity prevention: a systematic review

BACKGROUND: There is significant reporting on evidence-based research in the literature regarding lifestyle modification programs. There is a need to review and synthesize results in order to develop childhood obesity prevention and intervention strategy recommendations.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Parent-only interventions in the treatment of childhood obesity: a systematic review of randomized controlled trials

BACKGROUND: An effective and cost-effective treatment is required for the treatment of childhood obesity. Comparing parent-only interventions with interventions including the child may help determine this.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

A systematic review of home-based childhood obesity prevention studies

BACKGROUND AND OBJECTIVES: Childhood obesity is a global epidemic. Despite emerging research about the role of the family and home on obesity risk behaviors, the evidence base for the effectiveness of home-based interventions on obesity prevention remains uncertain. The objective was to systematically review the effectiveness of home-based interventions on weight, intermediate (eg, diet and physical activity [PA]), and clinical outcomes.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review

BACKGROUND: The prevalence of childhood obesity is increasing rapidly in low- and middle-income countries, and informed policies to tackle the problem must be defined.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Systematic review and meta-analysis of the association between childhood overweight and obesity and primary school diet and physical activity policies

Obesity is a major public health concern and there are increasing calls for policy intervention. As obesity and the related health conditions develop during childhood, schools are being seen as important locations for obesity prevention, including multifaceted interventions incorporating policy elements. The objective of this systematic review was to evaluate the effects of policies related to diet and physical activity in schools, either alone, or as part of an intervention programme on the weight status of children aged 4 to 11 years. A comprehensive and systematic search of medical, education, exercise science, and social science databases identified 21 studies which met the inclusion criteria. There were no date, location or language restrictions. The identified studies evaluated a range of either, or both, diet and physical activity related policies, or intervention programmes including such policies, using a variety of observational and experimental designs. The policies were clustered into those which sought to affect diet, those which sought to affect physical activity and those which sought to affect both diet and physical activity to undertake random effects meta-analysis. Within the diet cluster, studies of the United States of America National School Lunch and School Breakfast Programs were analysed separately; however there was significant heterogeneity in the pooled results. The pooled effects of the physical activity, and other diet related policies on BMI-SDS were non-significant. The multifaceted interventions tended to include policy elements related to both diet and physical activity (combined cluster), and although these interventions were too varied to pool their results, significant reductions in weight-related outcomes were demonstrated. The evidence from this review suggests that, when implemented alone, school diet and physical activity related policies appear insufficient to prevent or treat overweight or obesity in children, however, they do appear to have an effect when developed and implemented as part of a more extensive intervention programme. Additional evidence is required before recommendations regarding the focus of policies can be made and therefore, increased effort should be made to evaluate the effect of policies and policy containing intervention programmes upon weight status.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Obesity control in Latin American and US Latinos: a systematic review

CONTEXT: Latinos are the largest and fastest-growing ethnically diverse group in the U.S.; they are also the most overweight. Mexico is now second to the U.S. in experiencing the worst epidemic of obesity in the world. Objectives of this study were to (1) conduct a systematic review of obesity-related interventions targeting Latinos living in the U.S. and Latin America and (2) develop evidence-based recommendations to inform culturally relevant strategies targeting obesity.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis

Studies have reported inconsistent results concerning the association of cesarean section with offspring obesity. We performed a systematic review and meta-analysis to examine whether cesarean section increases the risk of later overweight and obesity. Pubmed, Embase and Web of Science were searched using different combinations of two groups of keywords: 'cesarean' and 'overweight/obesity'. Cohort or case-control studies that reported the association of cesarean section with childhood (3-8 years), adolescence (9-18 years) and/or adult (>19 years) overweight/obesity were eligible. Where possible, adjusted risk estimates were pooled using a random effects model; otherwise unadjusted estimates were pooled. Statistical heterogeneity was assessed with I(2) statistics; the values of 25%, 50% and 75% were considered to indicate low, medium and high heterogeneity, respectively. We conducted a subgroup analysis to identify the sources of heterogeneity according to study quality defined on the basis of the Newcastle-Ottawa Scale. In total, two case-control and seven cohort studies were identified for the literature review and 15 separate risk estimates were included in the meta-analysis. The overall pooled odds ratio (OR) of overweight/obesity for offspring delivered by cesarean section compared with those born vaginally was 1.33 (95% confidence interval (CI) 1.19, 1.48; I(2)=63%); the OR was 1.32 (1.15, 1.51) for children, 1.24 (1.00, 1.54) for adolescents and 1.50 (1.02, 2.20) for adults. In subgroup analysis, the overall pooled OR was 1.18 (1.09, 1.27; I(2)=29%) for high-quality studies and 1.78 (1.43, 2.22; I(2)=24%) for medium-quality (P for interaction=0.0005); no low-quality studies were identified. The ORs for children, adolescents and adults all tended to be lower for high-quality studies compared with medium-quality studies. Our results indicated that cesarean section was moderately associated with offspring overweight and obesity. This finding has public health implications, given the increase in cesarean births in many countries.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Health information technology in screening and treatment of child obesity: a systematic review

The authors concluded that childhood obesity studies showed promise for telemedicine to expand treatment access and for electronic health records to assist adherence to screening guidelines. The effect on weight loss and behaviour change remained understudied and inconsistent. Given the potential for review bias and the limitations of the evidence, the authors' conclusions regarding treatment benefit may be overstated.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis

The authors concluded that lifestyle interventions incorporating dietary, exercise and/or behavioural therapy components were effective in treating childhood obesity under various conditions at least up to one year. This was a generally well-conducted review but variations in intervention durations, settings and components precluded identification of the format likely to work best in practice and in the long-term.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

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